長期以來，腺癌組織學、雌性、不吸煙狀態(tài)以及亞洲族群被認為是和非小細胞肺癌患者EGFR（表皮生長因子受體）突變相關的重要因子；近日，一項刊登在國際雜志Journal of Thoracic Oncology上的研究報告中，來自中國北京癌癥研究所的研究人員通過研究表明，在亞洲人群中EGFR突變的頻率相比之前報道的要高。
文章中，研究者表示，通過對亞洲7個區(qū)域大約1450位肺癌患者的研究發(fā)現(xiàn)，在IIIB和IV期病人機體中EGFR突變的頻率為51.4%，而此前的報道大約為30%左右。
EGFR突變頻率在女性中為61.1%，在從不吸煙的個體中為60.7%；而EGFR突變頻率在男性中為44%，在偶然吸煙者機體中為51.6%；在亞洲區(qū)域中EGFR突變率最高的地區(qū)在越南，為64.2%，最低的區(qū)域在印度，為22.2%。
研究者Yuankai Shi博士表示，通過進行人口統(tǒng)計以及在臨床亞群上對EGFR突變頻率的研究揭示，EGFR突變的檢測應當在處于IIIB和IV期的肺癌亞洲病人中進行，這對于幫助病人及時改善治療策略以及確定其最佳的療法非常關鍵。
原文鏈接：
A Prospective, Molecular Epidemiology Study of EGFR Mutations in Asian Patients with Advanced Non–Small-Cell Lung Cancer of Adenocarcinoma Histology (PIONEER)
Shi, Yuankai MD*; Au, Joseph Siu-Kie MD†; Thongprasert, Sumitra MD‡; Srinivasan, Sankar MBBS§; Tsai, Chun-Ming MD‖; Khoa, Mai Trong MD¶; Heeroma, Karin Dr Med Sc#; Itoh, Yohji PhD**; Cornelio, Gerardo MD††; Yang, Pan-Chyr MD‡‡
Introduction: PIONEER (NCT01185314) was a prospective, multinational, epidemiological study of epidermal growth factor receptor (EGFR) mutations in patients from Asia with newly diagnosed advanced lung adenocarcinoma. Methods: Eligible patients (aged ≥20 years) had untreated stage IIIB/IV adenocarcinoma. The EGFR mutation status (primary end point: positive, negative, or undetermined) of tumor samples (biopsy, surgical specimen, or cytology) was determined (Scorpion amplification refractory mutation system). EGFR mutation frequency was calculated and compared between demographic and clinical subgroups. Results: Of 1482 patients from seven Asian regions, 43.4% of patients were female, median age was 60 years (range, 17–94), and 52.6% of patients were never-smokers. EGFR mutation status was evaluable in tumors from 1450 patients (97.8%) (746 [51.4%] positive; 704 [48.6%] negative). Country, sex, ethnicity, smoking status, pack-years (all p < 0.001), disease stage (p = 0.009), and histology type (p = 0.016) correlated significantly with EGFR mutation frequency. Mutation frequency was 61.1% in females, 44.0% in males; lower in patients from India (22.2%) compared with other areas (47.2%–64.2%); highest among never-smokers (60.7%); and decreased as pack-year number increased (>0–10 pack-years, 57.9%; >50 pack-years, 31.4%) (similar trend by sex). Ethnic group (p < 0.001) and pack-years (p < 0.001) had statistically significant associations with mutation frequency (multivariate analysis); sex was not significant when adjusted for smoking status. Conclusion: PIONEER is the first prospective study to confirm high EGFR mutation frequency (51.4% overall) in tumors from Asian patients with adenocarcinoma. The observed high mutation frequency in demographic/clinical subgroups compared with white populations suggests that mutation testing should be considered for all patients with stage IIIB/IV adenocarcinoma, even males and regular smokers, among Asian populations.
